Hearts, Volume 6, Issue 2 (June 2025) – 4 articles

Catheter ablation (CA) was found to outperform antiarrhythmic drug therapy (AAD), and it is a key treatment for rhythm control for patients with symptomatic atrial fibrillation (AF). Nevertheless, the procedure’s effectiveness is limited by recurrence rates. Identifying determinants of effective ablation is critical for optimizing patient selection, operative results, and long-term rhythm management strategies. In this state-of-the-art review, we have comprehensively discussed the various factors that can determine the recurrence of AF after a successful CA. Full article

Background/Objectives: The complexity of Minimally Invasive Mitral Valve Surgery (MIMVS) could cause a slow learning curve and potentially patient harm. We thus investigated if a novice mitral valve center encountered difficulties implementing MIMVS. Methods: We investigated seven hundred and forty-eight mitral valve surgery patients, two years before and after MIMVS introduction. Results: We propensity score matched two hundred and sixty elective mitral valve patients for comparison, with one hundred and thirty patients in each group. Surgical- (5.5 vs. 4.3 h), Cardiopulmonary bypass- (180 vs. 102 min) and aortic cross-clamp times (98 vs. 81 min) became longer after MIMVS introduction. One-year mortality and in-hospital outcomes remained unaffected. Hospital length of stay shortened significantly after MIMVS (5 d vs. 7 d; p < 0.001). Conclusions: Adopting MIMVS in a mitral valve center without prior experience in the procedure showed feasibility, equally good outcome and shorter hospital stay when compared to conventional sternotomy. Full article

Adult congenital heart disease (ACHD) represents a significant portion of congenital anomalies, and with improved treatments leading to an increased life expectancy, its prevalence has been increasing over the past few decades. Nonetheless, a considerable number of patients with ACHD require cardiac rhythm management devices during their lifetime. Traditionally, transvenous pacemaker placement has been the standard mode of treatment for these patients. However, some patients with ACHD have anatomical barriers that obscure this mode of treatment. Leadless pacing systems (LPSs) have changed the field of pacing. Currently, two different LPSs are available. In a real-world setting, implanting an LPS in patients after tricuspid valve (TV) surgery seems to be a straightforward procedure with a low risk of complications, with patients showing no valvular dysfunction after the intervention. LPS implantation is an option to avoid device-related complications in patients with previous TV surgery. Moreover, it has been demonstrated that even the jugular approach seems as safe as the femoral approach and could be considered an alternative implantation method for LPSs. The Aveir VR leadless pacemaker is a helix LPS with unique features, such as its capacity as a dual-chamber leadless pacemaker, the ability to map electrical parameters before releasing the device, and its possibility of being retrievable. Hereby, we present the case of Ebstein’s anomaly, atrial septal defect closure, and previous TV surgery with symptomatic intermittent advanced atrioventricular block. This case illustrates that a transjugular approach for LPSs is also feasible in patients with ACHD. Full article

Right heart failure (RHF) is a common manifestation after left ventricular assist device (LVAD) placement and is associated with a high mortality rate. Historically, RV failure requiring an RVAD at the time of LVAD implantation has been associated with an especially high mortality. However, more recently, some studies have shown reasonable outcomes after LVAD implantation even when an RVAD is required, especially if RV failure is recognized early and treated with RV mechanical support. This article analyzes the current trends and studies investigating the use of RVAD placement post-LVAD implantation with an emphasis on the newest devices and treatment paradigms. Full article